Citing the serious adverse effects of long-term medication, a doctor convinces the family of a female patient for surgery. This led the patient to reluctantly consent for the surgery, though her original choice was to opt for medication. Explain the concepts of paternalism and beneficence by analysing the doctor’s action.
10 marks · answer in 150 words · directive: Explain
The core of a good answer
The doctor acted from beneficence (seeking the patient's good) but in a paternalistic way, routing persuasion through the family and overriding a competent adult's choice; consent given reluctantly under family pressure is not genuinely free, so beneficence here crossed into unjustified paternalism.
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What the question asks
Define the two concepts and apply them to the case. The key is to show that beneficence is a duty to promote the patient's welfare, while paternalism is overriding a person's choice for her own good; the patient's autonomy is the deciding test.
Answer outline
Introduction
Medical ethics rests on four principles: autonomy, beneficence, non-maleficence and justice. The case sets beneficence against autonomy.
Beneficence
- The duty to act in the patient's best interest; explaining serious long-term side effects of medicines is part of it.
- The doctor's intent appears beneficent, not self-serving.
Paternalism
- Overriding or bypassing a person's choice for her own good.
- Soft paternalism is acceptable when the person lacks capacity or information; hard paternalism overrides a competent, informed choice.
- Here the patient was a competent adult; persuading the family to pressure her is hard paternalism, possibly compounded by family dynamics around a woman patient.
Analysis of the doctor's action
- Right: sharing risks of long-term medication.
- Wrong: going through the family instead of the patient; reluctant consent under pressure weakens voluntariness.
- Better: explain both options and their risks directly to the patient, give time, respect her decision, offer a second opinion.
Conclusion
Beneficence must work through the patient's autonomy, not around it; good intentions do not license pressure.
Examples and data to cite
- Samira Kohli v Dr. Prabha Manchanda (Supreme Court, 16 January 2008): for a competent adult patient, no one else can give consent on her behalf; consent for one procedure does not extend to another.
- Common Cause v Union of India (Supreme Court, 2018): recognised the right to die with dignity and advance directives, affirming patient autonomy.
- J.S. Mill, On Liberty (1859): harm principle; a person's own good is not sufficient warrant for interfering with her liberty.
Facts to remember
- Beauchamp and Childress, Principles of Biomedical Ethics (first edition 1979): autonomy, beneficence, non-maleficence, justice.
- Valid consent must be informed, voluntary and given by a person with capacity.
Where it sits in the syllabus
- GS4: Ethics and human interface; human values
Ethics and Human Interface: Essence, determinants and consequences of Ethics in human actions; dimensions of ethics; ethics in private and public relationships. Human Values: lessons from the lives and teachings of great leaders, reformers and administrators; role of family, society and educational institutions in inculcating values.
- GS4: Moral thinkers and philosophers
Contributions of moral thinkers and philosophers from India and world.
- GS4: Case studies
Case Studies on above issues.